Nursing Diagnosis of Prolonged Labour

Nursing diagnosis of Prolonged labour

Nursing Diagnosis of Prolonged First stage of labour

• There is no definite fixed time duration for the first stage. However, labour is considered to be prolonged if it lasts for more than 12 hours in a primipara and more than 8 hours in a multipara.
• In the active phase the cervix dilates at the rate of 1 cm per hour. When labour is prolonged, the rate of cervical dilatation will move to the right of the graph for normal labour (normogram) in the partogram.
• The alert line is drawn 2 hours to the right of the normogram and the action line is 4 hours to the right.
• Delayed progress is diagnosed when the rate of cervical dilatation is less than 2 cm in 4 hours.

When delay occurs the following parameters
should be assessed.

• The frequency and strength of uterine contractions.
• Descent and position of the foetal head.
• Features of early obstruction of labour (caput and moulding).
• The foetal condition.
• The maternal condition.

A cause for the delay must be found. This may either be due to inadequate contractions, or due to obstruction caused by, cephalopelvic disproportion, a malpresentation, a malposition (such as occipito-posterior position), foetal abnormality, uterine abnormality or a combination of these.

Primary Dyfunctional Labour

• Labour is slow from the start due to inadequate contractions.
• Treatment is augmentation of labour by artificial rupture of membranes followed by an oxytocin infusion, in the absence of
  maternal and foetal compromise, cephalopelvic disproportion, or any other cause of obstruction.
• Continuous foetal heart rate monitoring is commenced and progress is reviewed after 2 hours.
• Adequate pain relief is essential and the patient should be well hydrated.
• Preparations should be kept ready to perform a caesarean section at short notice.

Secondary Arrest – Nursing diagnosis of Prolonged labour

The progress is normal at first, but stops later in the presence of strong uterine
contractions, due to some form of obstruction, which could be foetal or maternal in origin.
It is treated by caesarean section. Prolonged or obstructed labour in a primigravida will cause uterine atony, while in a multipara it will result in uterine rupture. Therefore, multiparous women with delayed progress must be viewed with extreme caution.

Nursing Diagnosis of Prolonged Second stage of labour

• The second stage is prolonged if it lasts for more than 2 hours in a primipara and more than 1 hour in a multipara. (A further period of one hour is allowed if the patient is under epidural analgesia.)
• Therefore further observation is not recommended in most cases, as the time duration has been exceeded and immediate delivery is necessary.
• However in a primigravida with weak uterine contractions, with no evidence of foetal compromise or obstruction, an oxytocin infusion may be commenced and observed for 30 minutes.
• Instrumental delivery is carried out in suitable cases and caesarean section in others.

Read Also – stages sign and symptoms of Labour